Background Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. Few studies from India have evaluated the efficacy of different forms of therapy in achieving long-term remission. Materials and Methods This is a retrospective observational study of patients done over 15 years. Patients were stratified into low, moderate, or high risk category. Those in the moderate to high risk category received immunosuppressive therapy, including rituximab (RTX), cyclical cyclophosphamide (CTX) and corticosteroids, or tacrolimus (TAC). These patients were followed up for achievement of remission/nonresponse/relapse or progression to CKD. Results A total of 116 patients classified as moderate or high risk were started on immunosuppressive medications. A total of 105 patients were followed up for a mean of 7.5 years; 42% were in complete remission, 17% in partial remission at the last follow-up, and 19 patients had relapsed during the follow-up period. At the end of 1 year, the overall remission rate was 77.1%. (55.3% -complete remission, 22.7%-partial remission). The remission rates (complete plus partial remission) in the three groups were similar (75% in RTX, 75% in cyclophosphamide, 80% in TAC , p = 0.8). TAC was associated with a 2.8-fold higher risk of relapse than RTX ( p = 0.018). There was no statistically significant difference in complications between those who received either therapy. Conclusion There was no difference in remission rates among the three groups at 1 year. RTX was comparable to cyclophosphamide and TAC in achieving remission and good renal outcomes.
Eshwarappa et al. (Mon,) studied this question.
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